Healthcare Provider Details

I. General information

NPI: 1124638630
Provider Name (Legal Business Name): AMY STAGLIANO RAMIREZ PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2020
Last Update Date: 08/10/2020
Certification Date: 08/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1203 NW 16TH AVE
GAINESVILLE FL
32601-4674
US

IV. Provider business mailing address

4830 NW 43RD ST APT A8
GAINESVILLE FL
32606-4402
US

V. Phone/Fax

Practice location:
  • Phone: 352-373-7337
  • Fax:
Mailing address:
  • Phone: 904-327-4341
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT012419
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT29322
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: